Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial

ObjectiveTo investigate whether 4-month preoperative lanreotide treatment would improve the surgical cure rate of newly diagnosed acromegalic patients with macroadenomas.DesignA prospective, randomised study.MethodsAfter a baseline evaluation, patients were randomly assigned to 4-month preoperative treatment with lanreotide (starting with 30 mg/2 weeks i.m. and increasing to 30 mg/week i.m. at week 8 if mean GH >2.5 μg/l on GH day curves; pretreatment group, Group 1) or to transsphenoidal surgery (direct surgery group, Group 2). Cure was evaluated 4 months postoperatively primarily by fasting IGF1 less than or equal to age-adjusted upper limit of normal.ResultsA pool of 108 patients was randomly divided into two groups. Five patients in each group were lost to follow-up during the study period, so 49 patients in each group were analysed. At baseline, no difference was observed between the two groups. Cure was established in 24 of 49 (49.0%, 95% confidence interval (CI), 35.0–63.0%) pretreated patients (Group 1) versus 9 of 49 (18.4%, 95% CI, 7.6–29.2%) direct surgery patients (Group 2;P=0.001). Surgical morbidity was recorded in 12 patients (12.2%) and was similar in Group 1 and 2 patients (14.3 and 10.2% respectively;P=0.538). The postoperative hospital stay was similar between groups: being 4.5±1.6 days in Group 1 vs 4.8±1.9 days in Group 2 (P=0.328).ConclusionsPretreatment with lanreotide before transsphenoidal surgery improves surgical cure rates in patients with GH-secreting pituitary macroadenomas. Pretreatment does not affect surgical complications or duration of hospital stay (ClinicalTrials.gov number, NCT00993356).

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Efficacy of Probiotic Saccharomyces boulardii as an Adjuvant Therapy in Acute Childhood Diarrhoea

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v36i3.15539 ◽

2017 ◽

Vol 36 (3) ◽

pp. 250-255 ◽

Cited By ~ 5

Author(s):

Dillip Kumar Dash ◽

Mrutunjaya Dash ◽

M.D. Mohanty ◽

Naresh Acharya

Keyword(s):

Hospital Stay ◽

Tertiary Care ◽

Acute Diarrhoea ◽

Oral Rehydration Therapy ◽

Saccharomyces Boulardii ◽

Care Hospital ◽

Oral Rehydration ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Introduction: Administration of S. boulardii in addition to rehydration therapy in diarrhea found to be beneficial in many aspects owing to a variety of causes and importantly it is was not associated with any adverse effects.Material and Methods: We conducted a prospective study of children suffering from acute diarrhoea, at a private tertiary care hospital. Children were divided into 2 groups randomly as per odd(Group 1 ) and even (Group 2) bed allotted in indoor at the time of admission: Group 1 included children on oral rehydration therapy (ORT) + Zinc + Saccharomyces boulardii (Probiotic 5 billion CFU twice daily) and Group 2 comprised of children on ORT+ Zinc. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhoea.Results: Out of a total of 126 children less than 2 years, 2-6 years and 6-14 years were 72 (57.14%), 42(33.33%) and 12(09.52%) respectively. The duration of diarrhoea in Group 1 was 26.31 hours and Group 2 was 47.81 hours (p<0.01). The frequency of diarrhoea showed improvement within 24 and 72 hours in Group 1 and Group 2 respectively (p<0.01).Similarly, the mean duration of hospital stay was 2.68 days in Group 1 and 4.8 days in Group 2.The treatment cost was INR 850 and INR 1650 while social cost was INR 1250 and 2600 in Group 1 and 2 respectively.Conclusion:This study shows that S. boulardii reduced the duration, frequency and hospital stay of diarrhoea thereby reducing the treatment and social costs.J Nepal Paediatr Soc 2016;36(3):250-255

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Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

Hospital Pharmacy ◽

10.1177/00185787211037540 ◽

2021 ◽

pp. 001857872110375

Author(s):

Frank A. Fanizza ◽

Jennifer Loucks ◽

Angelica Berni ◽

Meera Shah ◽

Dennis Grauer ◽

...

Keyword(s):

Hepatitis C ◽

Medication Adherence ◽

Hcv Treatment ◽

Clinical Pharmacists ◽

The Mean ◽

Group 2 ◽

Cure Rates ◽

The Impact ◽

Mean Time ◽

Group 1

Background: Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Objectives: Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. Methods: We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). Results: The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; P < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; P < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Conclusion: Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.

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Comparative study of laparoscopic hernia repair versus open hernia repair

Journal of Nobel Medical College ◽

10.3126/jonmc.v7i2.22303 ◽

2018 ◽

Vol 7 (2) ◽

pp. 30-34

Author(s):

Rohit Prasad Yadav ◽

Dipendra Thakur ◽

Bashu Dev Baskota ◽

Amit Kumar Shah ◽

Kaushal Samsher Thapa ◽

...

Keyword(s):

Hernia Repair ◽

Comparative Study ◽

Hospital Stay ◽

Laparoscopic Hernia Repair ◽

Fatty Tissue ◽

Duration Of Surgery ◽

Group 2 ◽

Lower Pain Score ◽

Open Hernia Repair ◽

Group 1

Background: Hernia is the abnormal exit of an organ or fatty tissue, such as the bowel, through the weak wall of the cavity in which it normally resides. Repair of inguinal hernia is common surgical procedures. This study aims to compare between laparoscopic and open hernia repair. Method: Study is non randomized comparative study. Study includes 76 patients who had undergone surgery for hernioplasty. Among them 38 undergone laparoscopic hernioplasty and 38 undergone open hernioplasty from June 2016 to August 2018. Results: Mean hospital stay was 2.95 days in group 1 and 4.03 in group 2 .VAS was found to be 2.45 in group 1 and 5.71 in group 2 which is significantly low in group 1 patients with p<0.001. Duration of surgery is more in group 1 with mean duration of 94.08 minutes comparing to group 2 with mean duration of 43.55 minutes (with p<0.001). Conclusion: Laparoscopic hernia repair offers advantages over open repair in terms of less hospital stay and lower pain score for patient not contraindicated for general anesthesia and complicated hernia.

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PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.218 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 112-112

Author(s):

Jeroen Hol ◽

Joos Heisterkamp ◽

Barbara Langenhoff

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Hospital Stay ◽

Minimally Invasive Esophagectomy ◽

Length Of Hospital Stay ◽

Morbidity And Mortality ◽

Tumor Type ◽

Invasive Esophagectomy ◽

Group 2 ◽

Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

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Comparable Outcomes with or without Routine Granulocyte Growth Factor Support Following Autologous Peripheral Blood Stem Cell Transplantation (PBSCT): A Single Center Experience.

Blood ◽

10.1182/blood.v114.22.1178.1178 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1178-1178

Author(s):

Harris V. Naina ◽

Shaji Kumar ◽

Shekhar Bitla ◽

Jeffrey Winters ◽

William Hogan ◽

...

Keyword(s):

Stem Cell ◽

Growth Factor ◽

Stem Cell Transplantation ◽

Hospital Stay ◽

Cell Transplantation ◽

Ambulatory Care Setting ◽

Group 2 ◽

Febrile Episodes ◽

Neutrophil Engraftment ◽

Group 1

Abstract Abstract 1178 Poster Board I-200 Background: High-dose chemotherapy with autologous peripheral blood stem cell transplantation (PBSCT) has been shown to be of value in selected patients with malignant lymphoma and multiple myeloma (MM). Both granulocyte macrophage colony stimulating factor (GMCSF) and granulocyte colony stimulating factor (GCSF) are widely used following stem cell transplantation to support accelerated myeloid recovery and potentially shorten hospital stay. In the recent years, PBSCT is increasingly done in an ambulatory care setting and it is not clear if routine growth factor use has any potential benefit. We undertook this study to compare engraftment kinetics, incidence of febrile episodes, hospitalization duration and other outcomes among transplants done with or without growth factor support Patients and Methods: We included adult patients undergoing PBSCT for myeloma and lymphoma between May 2007 and June 2009 in an ambulatory care setting. Prior to April 2008 (Group-1) all patients received GMCSF 500 mcg/ day starting on day 6 routinely. Since April 2008, there was a shift in clinical practice and routine use of GMCSF was discontinued due to lack of clear evidence regarding benefit. Patients transplanted between April 2008 and June 2009 did not routinely receive GMCSF (Group-2). Typical conditioning regimen for lymphoma was BEAM (BCNU, Etoposide, Cytosine Arabinose, Melphalan) and for multiple myeloma was melphalan 200mg/m2. Patients' demographics details, indication for PBSCT, duration of neutropenic fever, hospital stay, and neutrophil and platelet engraftment were collected from electronic medical records. Neutrophil engraftment is defined as the first day of 2 consecutive days when ANC was > 0.5 × 109/L and platelet engraftment is defined as first of 7 consecutive days on which patient's unsupported platelet count was greater than 20× 109/L. Results: A total of 309 were included in this study, 126 (40%) patients in group-1 (69 with MM, 57 with lymphoma) and 183 (60%) in group-2 (100 with MM, 83 with lymphoma). In group-1, 73 (58%) and in group-2 130 (71%) were male patients. Median age was 59 (29-74) years in group 1 and 58 (24-76) years in group-2. Patients in group 1 received a median of 3.65 (1.1-8.7) versus 4.37 (1.1-9.54) CD34+ x106/kg in group 2 (P =0.005). Median time to neutrophil engraftment was 12 (95% CI 12, 12) for group-1 and 14 (95% CI; 13-14) for group-2 (Kaplan Meier analysis; log rank P < 0.0001). Median estimated time to platelet engraftment was 14 days (95% CI; 13, 15) for group 1 and 13 days (95% CI; 13-13) for group 2 (Kaplan Meier analysis; log rank P 0.007). In group-1 98 (78%) patients developed febrile episodes compared to 117(64%) in group-2 (P = 0.009). Median duration of fever was 2 days (range, 1-8) in group-1 compared to 1 day (range, 1-8) in group-2 (P = 0.0003). The median (range) duration of hospital stay was 7 (1-40) days for group-1 compared to 8 (2-56) days for group-2 (P=NS). There was no significant difference in mortality between these two groups. Conclusion: Routine use of granulocyte growth factors is associated with a shorter time to neutrophil engraftment, but associated with a delay in platelet engraftment. The longer time to neutrophil engraftment without growth factor use does not translate into any increase in frequency of febrile episodes. On the contrary, higher number of febrile days is seen with use of growth factors, likely explained on the basis of drug fever. No difference in the frequency of engraftment syndrome or treatment related mortality was seen. Disclosures: No relevant conflicts of interest to declare.

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Final results of a phase I study of daily PI-88 as a single agent and in combination with dacarbazine (D) in patients with metastatic melanoma

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.8532 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 8532-8532 ◽

Cited By ~ 2

Author(s):

M. Millward ◽

A. Hamilton ◽

D. Thomson ◽

A. Gautam ◽

E. Wilson

Keyword(s):

Metastatic Melanoma ◽

Sinus Thrombosis ◽

Single Agent ◽

Cerebral Venous Sinus Thrombosis ◽

Randomised Study ◽

Concurrent Use ◽

Group 2 ◽

Recommended Phase Ii Dose ◽

Pet Scans ◽

Group 1

8532 Background: PI-88 is a heparan sulfate mimetic that inhibits angiogenesis and metastasis directly and via release of tissue factor pathway inhibitor (TFPI). PI-88 has shown some efficacy in an intermittent dosage regimen (250 mg/day 4 days/week) in melanoma (Thomson et al, ASCO 2005). This study tested PI-88 7 days per week alone (group 1) and in combination with 3 weekly D (group 2). Methods: Eligibility included inoperable metastatic melanoma, no prior chemotherapy, PS 0–1, adequate organ function, no recent use of heparin, negative anti-heparin antibody (AHA), no concurrent use of anti-coagulants or anti-platelet agents, no history of GI bleeding. Group 1 cohorts received daily PI-88 in doses of 140 mg, 190 mg and 250 mg. Group 2 received PI-88 commencing at the level below the single agent MTD plus D 1,000 mg/m2 every 21 days. Group 1 pts who had PD could continue PI-88 with the addition of D. FDG-PET scans were performed prior to and after 6 weeks PI-88 in Group 1. Free TFPI was measured in serum prior to and up to 2hr post first dose PI-88 in group 1. Results: Group 1 - DLT occurred in 0/3 (140 mg), 0/3 (190 mg) and 2/3 (250 mg) pts. Group 2 - DLT occurred in 1/6 (140 mg) and 0/4 (190 mg) pts. All DLTs were AHA positive grade III/IV thrombocytopenia with in 1 pt (250 mg) cerebral venous sinus thrombosis. No other major toxicities and no increase in expected DTIC toxicities were observed. 4 group 1 pts had pre/post PET scans. One pt had 50% fall in SUVmax with radiologic SD for 4 months. No radiologic responses occurred with PI-88 alone. 3/9 pts in group 2 had radiologic PR. 2/5 group1 pts who had D added to PI-88 had PR. Free TFPI increased from 6.9 ± 1.9 ng/ml just prior PI-88 to 56.1 ± 19.4 30 min post PI-88. The elevated levels were maintained at 60 and 120 min. Elevation of free TFPI did not correlate with PI-88 dose. Conclusion: The recommended phase II dose of continuous daily PI-88 is 190mg alone and in combination with D 1,000 mg/m2 every 3 weeks. An ongoing randomised study is comparing D 1,000 mg/m2 plus PI-88 190mg/day to single-agent D. No significant financial relationships to disclose.

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Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

Urologia Internationalis ◽

10.1159/000358731 ◽

2014 ◽

Vol 94 (1) ◽

pp. 25-30 ◽

Cited By ~ 13

Author(s):

Evi Comploj ◽

Jeremy West ◽

Michael Mian ◽

Luis Alex Kluth ◽

Alexander Karl ◽

...

Keyword(s):

Hospital Stay ◽

Radical Cystectomy ◽

Medical Center ◽

Oldest Old ◽

Age Group ◽

Cancer Specific Survival ◽

Old Patients ◽

Significant Difference ◽

Group 2 ◽

Group 1

Introduction: The purpose of this study was to evaluate and compare complications after radical cystectomy in patients aged ≥75 years. Materials and Methods: 251 patients aged 75-95 years (median 79) underwent radical cystectomy between 2000 and 2012 at four institutions. The patients were divided into two groups: ≥75-84 years of age (group 1) versus ≥85 years of age (group 2). Comorbidities, body mass index, and complications were obtained retrospectively, except at the Central Hospital of Bolzano and Weill Cornell Medical Center, which collected data prospectively. Cancer-specific survival, overall mortality, hospital stay, clinical outcome and complications were assessed. Complications were categorized using the Clavien-Dindo classification reporting system. The mean follow-up was 21 months. Results: The median hospital stay was 17 (2-91) days. Perioperative Clavien-Dindo grade ≥III complications were seen in 24.1% (48/199) of group 1 patients and 19.2% (10/52) of group 2 patients (p = 0.045). 30- and 90-day mortality was 4.5 and 13.5% in group 1 and 6.5 and 32.3% in group 2, respectively. Only the 90-day mortality rate was statistically significant (p < 0.05) between the two groups. The 3-year overall survival was 40% in group 1 and 34% in group 2. The 3-year cancer-specific survival was 52% in group 1 and 50% in group 2. Conclusions: We evaluated a large series of elderly (≥75 years) patients undergoing radical cystectomy at four institutions. Comparing patients aged ≥75-84 and ≥85 years revealed no significant difference in complications, 30-day mortality, overall and cancer-specific survival rates. Only 90-day mortality rates were significantly higher in the ≥85-year-old patients.

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Effect of vitamin D supplementation during pregnancy on neonatal mineral homeostasis and anthropometry of the newborn and infant

British Journal Of Nutrition ◽

10.1017/s0007114511006246 ◽

2012 ◽

Vol 108 (6) ◽

pp. 1052-1058 ◽

Cited By ~ 62

Author(s):

Pramila Kalra ◽

Vinita Das ◽

Anjoo Agarwal ◽

Mala Kumar ◽

V. Ramesh ◽

...

Keyword(s):

Vitamin D ◽

Usual Care ◽

Head Circumference ◽

Usual Care Group ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Care Group ◽

Randomised Study ◽

Group 2 ◽

Group 1

Hypovitaminosis D is common in India. In the present prospective partially randomised study of vitamin D (D3) supplementation during pregnancy, subjects were randomised in the second trimester to receive either one oral dose of 1500 μg vitamin D3(group 1,n48) or two doses of 3000 μg vitamin D3each in the second and third trimesters (group 2,n49). Maternal 25-hydroxyvitamin D (25(OH)D) at term, cord blood (CB) alkaline phosphatase (ALP), neonatal serum Ca and anthropometry were measured in these subjects and in forty-three non-supplemented mother–infant pairs (usual care). Median maternal 25(OH)D at term was higher in group 2 (58·7, interquartile range (IQR) 38·4–89·4 nmol/l)v. group 1 (26·2, IQR 17·7–57·7 nmol/l) and usual-care group (39·2, IQR 21·2–73·4 nmol/l) (P = 0·000). CB ALP was increased (>8.02 μkat/l or >480 IU/l) in 66·7 % of the usual-care groupv. 41·9 % of group 1 and 38·9 % of group 2 (P = 0·03). Neonatal Ca and CB 25(OH)D did not differ significantly in the three groups. Birth weight, length and head circumference were greater and the anterior fontanelle was smaller in groups 1 and 2 (3·08 and 3·03 kg, 50·3 and 50·1 cm, 34·5 and 34·4 cm, 2·6 and 2·5 cm, respectively)v. usual care (2·77 kg, 49·4, 33·6, 3·3 cm;P = 0·000 for length, head circumference and fontanelle andP = 0·003 for weight). These differences were still evident at 9 months. We conclude that both 1500 μg and two doses of 3000 μg vitamin D3had a beneficial effect on infant anthropometry, the larger dose also improving CB ALP and maternal 25(OH)D.

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Comparative study of pharmacological and combined pharmaco-mechanical method of induction of labour: a randomised study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211523 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1977

Author(s):

Anshu Kumari ◽

Mahantappa A. Chiniwar ◽

Sharada B. Menasinkai

Keyword(s):

Comparative Study ◽

Active Phase ◽

Induction Of Labour ◽

Research Centre ◽

Cervical Canal ◽

Mechanical Method ◽

Randomised Study ◽

Group 2 ◽

Foley’S Catheter ◽

Group 1

Background: Comparative study of Pharmacological and Pharmaco- Mechanical method of induction of labour- A Randomised study. The objective of the study was to compare efficacy of pharmacological and combined pharmaco-mechanical method of induction of labour.Methods: A study was conducted in the department of Obstetrics and gynaecology, Adichunchanagiri Institute of Medical Sciences and Research Centre for a period of 18 months. 200 pregnant women requiring induction of labour were included in the study. In group 1 Dinoprostone 0.5 mg gel was inserted into cervical canal. In group 2 Foley’s catheter No 18 F was inserted within the cervix. The balloon of the catheter was filled with 30 ml normal saline and at the same time Dinoprostone 0.5 mg gel was inserted into posterior vaginal fornix. The Excel and SPSS (SPSS Inc, Chicago V 18.5) software packages were used for data entry and analysis. The results were averaged (mean ± Std Deviation) for each parameter for continuous data in tables.Results: Mean induction to active phase interval in group 1 was 8.43±4.11 hrs, in group 26.82±3.01 hrs (p =0.001). The rate of vaginal delivery in group 1 and group 2 was 55% and 66% respectively, difference was statistically significant (p=0.026).Conclusions: Synchronous use of intracervical Foley’s catheter and Dinoprostone 0.5 mg resulted in a shorter time for progress to active phase and also shortened induction to delivery interval as compared to Dinoprostone 0.5 mg alone. Higher risk of caesarean delivery was associated with single method as compared to combined methods.

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Which factors affect the success of pediatric PCNL? Single center experience over 20 years

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.4.345 ◽

2020 ◽

Vol 92 (4) ◽

Author(s):

Volkan Izol ◽

Nihat Satar ◽

Yıldırım Bayazit ◽

Fatih Gokalp ◽

Nebil Akdogan ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Pediatric Patients ◽

Operation Time ◽

Fluoroscopy Time ◽

Postoperative Blood Transfusion ◽

Group 2 ◽

Group 1

Objective: We aimed to investigate the impact of surgeons’ experience on pediatric percutaneous nephrolithotomy (PCNL) outcomes. Materials and methods: Between June 1997 and June 2018, 573 pediatric patients with 654 renal units underwent PCNL for renal stone disease by senior surgeons. Data were divided into two groups, group-1 (n = 267), first ten years period, group-2 (n = 387); second ten years period. Results: Mean ± SD age of patients was 7.6 ± 4.9 (1-17) years. The stone-free rates (SFR) assessed after 4 weeks were 74.9% vs. 83.4% in group-1 vs. group-2, respectively (p = 0.03). The mean operation time, fluoroscopy time, and the number of patients requiring blood transfusion significantly decreased in group 2 (100.4 ± 57.5 vs. 63.63 ± 36.3, 12.1 ± 8.3 vs. 8.3 ± 5.4, and 24.3% vs. 2.9%; p < 0.001, p < 0.001, and p = 0.002 in group-1 versus group-2, respectively). On multivariate analysis, increasing stone size increased operation time (p < 0.001), fluoroscopy time (p < 0.001), intraoperative and postoperative blood transfusion rates (p = 0.006 and p = 0.018, respectively), and hospital stay (p = 0.002) but was not associated with change of glomerular filtration rate (GFR) (p = 0.71). Sheath size also correlated with increased fluoroscopy time (p < 0.001), operation time (p < 0.001), intraoperative blood transfusion (p < 0.001) and hospital stay, but sheath size did not affect postoperative blood transfusion (p = 0.614) or GFR change (p = 0.994). Conclusions: The percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure and is well accepted because of its lower complication rate and high efficiency for pediatric patients. Stone and sheath size are predictive factors for blood loss and hospital stay. During 20 years, our fluoroscopy time, operation time, blood loss, and complication rates decreased, and stone-free rate increased.

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